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The performance characteristics of latex agglutination tests are highly dependent on the manufacturer. Although Kutinsky et al¹ are aware of this fact, they extrapolate the poor performance of the latex agglutination test used in their study to all latex agglutination tests for D-dimer levels. In fact, many latex agglutination tests have sensitivities and negative predictive values, ranging between 94% and 100%, that match or exceed those of enzyme-linked immunosorbent assays.^2-3 The recommendation by the authors that latex agglutination tests not be used to evaluate patients with suspected pulmonary embolism is based on insufficient data. The Yugo was a lemon, but not all cars are poorly engineered.

Paul Fiedler, MD
New Haven, Conn

1. Kutinsky I, Blakley S, Roche V. Normal D-dimer levels in patients with pulmonary embolism. Arch Intern Med. 1999;159:1569-1572. FREE FULL TEXT 2. Duet M, Benelhadj S, Kedra W, Vilain D, et al. A new quantitative D-dimer assay appropriate in emergencies: reliability of the assay for pulmonary embolism exclusion diagnosis. Thromb Res. 1998;91:1-5. FULL TEXT | ISI | PUBMED 3. Heit JA, Miner TA, Andrew JC, Larson DR, Li H, Nichols WL. Determinants of plasma fibrin D-dimer sensitivity for acute pulmonary embolism as defined by pulmonary angiography. Arch Pathol Lab Med. 1999;123:235-240. ISI | PUBMED

Arch Intern Med. 1999;159:2485.